Organization · Type 2 NPI

Walgreen Co

Pharmacy · Decatur, IL

NPI number 1114932415 Active

Practice location

4995 E US Route 36
Decatur, IL 62521-9701

Call (217) 864-9455 Map

Mailing address

1901 E Voorhees St, Ms 790
Danville, IL 61834-4515

Specialties and licenses

Taxonomy	Code	License
Durable Medical Equipment & Medical Supplies	332B00000X	None listed
Pharmacy Primary	333600000X	54006282 (IL)
Community/Retail Pharmacy	3336C0003X	None listed

Pharmacy: A facility used by pharmacists for the compounding and dispensing of medicinal preparations and other associated professional and administrative services. A pharmacy is a facility whose primary function is to store, prepare and legally dispense prescription drugs under the professional supervision of a licensed pharmacist. It meets any licensing or certification standards set forth by the jurisdiction where it is lo…

4 other providers at this address

Other pharmacy providers in Decatur

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NPI record

NPI: 1114932415
Entity type: Organization (Type 2)
Issued: Jul 29, 2006
Last updated: Nov 21, 2025
Status: Active
Subpart: Yes of Walgreens Boots Alliance Inc

Other names

<unavail>
Walgreens #05719 · doing business as
Walgreens #05719 · doing business as

Authorized official

Jennifer Ponce
Manager
(847) 527-2489

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This page mirrors the public NPPES file. For credentialing or billing, confirm it on the official CMS NPI Registry, and check the license with the state board.

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About NPI 1114932415

Walgreen Co's National Provider Identifier is 1114932415, issued on Jul 29, 2006. The primary taxonomy on file is Pharmacy (333600000X), and the practice location is in Decatur, IL. The record was last updated on Nov 21, 2025.